HomeMy WebLinkAbout13231-zFORM NO. 4
TOWN OF 5OUTHOLD
DUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z14834
August 22 86
Date .................. ,19
THIS CERTIFIES that the building Pool ·
Location of Property ,.~ 2. p.~N., p.R.,..~..9.5. 2. 9...~.w...S.U.F.F. 9.L.K..A..V.E.. ..... .C. qT..C.~.O.G.U.E. ....
House IVo. Street Hamleg
1.16 BI k 5 L 4
County Tax Map No. 1000 Section . dC ........ ot ...............
Subdivision. ~Q~I~I~.V. ISg7 ................... Filed Map No..5.5.0.9.,, .Lot No. 3
conforms substantially to the Application for Building Permit heretofore filed in this office dated
132315
June 1.4, 19 8.4. pursuant to wlfich Building Permit No .................
dated ....J.u,n.e...1.8, ................ 19..8.4, was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
.X¢gxo. und .sw$.m[q..ing pool,fence & deck attached t.o.e.x, is..ting..o.ne f. amily
dwe 11 ing.
The certificate is issued to ........... JJq~I~DA .~. J.A.M.E.S...C.O.R..C9..R~.N' ....................
{owner~X~X
of the aforesaid building.
Suffolk County Department of Health Approval .... .N/A ..................................
UNDERWRITERS CERTIFICATE NO ............ ¢15.5.2 Q }.0 ..............................
'" ~ ~itiiicii~ig lnil;~C't;r ........
Rev, 1/81
FOB. Ir( NO. 9
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y,
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 13231 Z
pursuant to application dated ....... j~.~...~ .......................... , 19..~...~.., and approved by the
Building Inspector.
Fee $....~.! ..................
Building Ir~:~ctor
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N,Y, 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
1 8 1986
Instructions
This application must be filled in typewriter OR ink, and submitted m ~mm,~a to the Building Inspec-
tor with the following; for new buildings or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
natural or topographic featu res.
2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, industrial buildings, Multiple Residences and sfmilar buildings and installa-
tions, a certificate of Code compliance from the Architect or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or
topographic features.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings.
3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling $15.0 0
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00 ~/~ '~'//'~'///~'
5. Updated C.O. $15.00 P~// Date ...............
New Building ..... /'~.~).... Old or Pre-existing Building ............ Vacant Land .............
Location of Property ..........................................
House No. Street Ham/et
Owner or Owners of Property ........... .~ .....~..~¢.¢.~. ~ ...... .f?.d~..~../?.~'..../~. ............
County Tax Map No. 1000 Section ............... Block ............... Lot ................
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........ Date of Parmit .......... Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ ...............
Construction on above described building and permit meets all applicable codes and regulations.
Applicant '..~.,. c~/~.~ ~ .C~..7~. ~?,~./~z.~._
Rev. 10-10-78
THE NEW YORK BOARD OF FIRE UNDERWRITERS
85 JOHN STREET, NEW YORK, NEW YORK 10038 ~
~ate Jtfly ~7~ .1.984 ,~pplication~o. on.file mo:~z/s4 N 652030
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applgcant named on the above application number in the premises of
~ Cor~oran~ De~u I~ive at c~rner of New ~f~o~k Ave., C~c~g~, N.Y,
i. th~ followlng Io¢.tion;[] B.~ment [] 1st ri. [] 2nd ri. OV~SJ~ Section Btoch rot
was examined on and found to be in compliar~ce with the requirements of this Board.
FIXTURE FIXTURES RANGES OVENS
EXHAUST FANS
OUTLETS
1
DRYERS
OTHER APPARATUS:
E
NO, O~E~C~COND.
R V I C E
1-G.F. I.
OF NEUTRAL
run mu;[ulmu U:FRfl/MEN[, THIS COPy OF CERTIF!CATEMUST NOT BE ~TERED ~N ANY MANNER '~J
7GS.'1802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION ZND [ ] INSULATION
[ ] FRAMING
[ ] FINAL
REMARKS:
765-'~802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG,
[] FOUNDATION 2ND [~]~JLATION
]FRAMING ~]~ FINAL
REMARKS:
~IE'L~ INS?ECTION
COMMENTS
FOUNDATION (lst)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
C,ODE
ADDITIONAL COMMENTS:
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLO, N.Y. 11971
TEL.: 765-1802
Examined . .~. ~ ...., 19 .
Approved .~.c4,!~&..}..~...., 19~. .~. Permit No.). .~...~.~. )..~. ·
Disapproved a/c .....................................
................................ .......
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Application No ..................
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throu~aout the work,
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspections. ~
.... .~. :.tf.e/. .~. ~ ./. . . ¢. .5. ~. .*.~. . . /.~. . .~.
(gighature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
....................................... .........................................
Name of owner of premises . ~ ./ri .~,~:: ..~. ~.~') ~'.&O.~... ~ .O./~..~..O..~ .~. .............................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of~luly authorized officer.
(Name and title of corporat0g'officer)
Builder's License No ...... .,f~-~ .................
Plumber's License No .........................
Electrician's License No....~../~.,,,~.~.~..e'~/f.. ~ .......
Other Trade's License No .................... o/~,~:~__-O ~l,)~t4,~) -
1. Locatmnoflandonwlnchproposedworkw~ bedo e. ,- ?.·._.,_ ~ ,-7,,_~r ..,r _,n,~,. ~
....................... ~ ~ . .~e~W. . .ZPX/.~. , .......... ~, ~. .7: ~.~.~. .<.~. ¢. . .~. ./. . .
House Number Street Hamlet
.... ....... ....... .... ........
Subdivision .... ~./,~2/t/~...~../.~. .............. Filed Map No.. ~.yZ~).~. ...... Lot.. · .-'~.. · .........
(Name)
2. State existing use and occupancy of premises and intended use and occupanqy of proposed construction:
a. Existing use and occupancy.. 4 "~' '~' '~' '/'~'~'''' '~' ' '~/' '~' '~:' '~' '/' "~' '~' "' ..............................
b. Intended use and occupancy .Z(..~..~.~.~ -- 5/,~'~"',~" '~-,~ .
......... ~.~..~.. ,,.~:.., ,........ !~.~...o...z.,,, . .,,~-,,~..c~,.. ~-.,,~.. c~...
3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
4~ (Description)
4. Estimated Cost .~ OOo.~*e$ Fee ~/.0.!.
(to be paid on filing this application)
5. If dwelling, number of dwellinglunits ............... Number of dwelling units on each floor ................
If garage, number of cars ........................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ...............
Height ............... Number of Stories ..... ' ...................................................
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
Depth ...................... Height ...................... Number of Stories ......................
8. Dimensions of entire new construction: Front ............... Rear ............... Depth ...............
Height ............... Number of Stories ........................................................
9. Size of lot: Front ...................... Rear ...................... Depth ......................
10. Date of Purchase ............................. Name of Former Owner '. ............................
11. Zone or use district in which premises are situated .....................................................
12. Does proposed construction rio!ate any zoning law, ordinance or regulation: ................................
13. Will lot be regraded ........................ .... Will excess fill be removed from premises: Yes No
14. Name of Owner of premises .................... Address ................... Phone No ................
Name of Architect ........................... Address ................... Phone No ................
Name of Contractor .......................... Address ................... Phone No ................
PLOT DIAGRAM
Locate ,clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block'number~ or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF N[W~/"~Ir~/.,/./~ S S
COUNTY OF~.ke.. '
.......... ~" ' ~"' ./d,'(. ~.',~'~. ~. ~ .. ~ ~...'' being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the ~ ~ ~ .~.
(Contractor, agent, corporate officer, etc.)
of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e ~d file this
application;~ that all statements contained ~ this application am true to the best of his knowledge and belief; and that the
work will be perfomed in the m~ner set forth in the application filed therewith.
Sworn to before me this
............ ,.Z~-: · · .day of ....~~ ~ ......... 1~.
Not~: ublic, . ..... ~..~..~...--~County
{' [ '~~ ~ffi (Signa~re of applicant)
land
~nked
by location from }~ou~e owner* and field
obse~vallon~, $inca moat wells and cass*
pooll are nat vi*lble Ihese dimensIone
cannot be certified, ', ~
AP?:~;U'7, L'i AS NOTED
----,._..___.B.p.
FEE: ,
765-1802 9 A~'FO 4 PM FOR
~OLLOwfNG /~ECTIONS:
' ':~ ) CONCRETE
- FR~[NG'& PLUMB
BE COMp ,,r'FF ,~()R~ ("-. ' 0,'
NOT RE?ONSIBLF
OR CONSTRuCTioN
APP OVE AS NOTED
NOTIFY rILDING DEPARTMENT AT
'~5-~802 9 AM TO 4 PM FOR THE
FQLLOWING INSPECTIONS:
1: ~UNDATION - TWO REQUIRED
FOR POURED CONCRETE
· 2. ROUGJa - FRAMING & PLUMBING
,, 3. INC:U[.AT?~N'
' "'"' .,,ALL CQNrqTRr ~CTION SHALL MEET
......... ' ' '"er , ? '* ,' " 'THE RE?I!P''MENTS OF TJr: i~ Y
CONSTRUCTION ERRORS.